Academics, Safety & Quality

Academics

Saint Francis Hospital and Medical Center is affiliated to University of Connecticut School of Medicine and its Internal Medicine Residency Program. AIMS hospitalists supervise, teach and mentor UConn medical students and residents during their ward rotations. We also are involved with Quinnipiac University in training their Advanced Practice Professional (APP) students.

Publications:

Quality & Safety

The AIMS hospitalist group is actively involved in multiple quality and patient safety initiatives within the hospital. For a complete list of QI projects please contact the AIMS director/section chief. Here is a sample of projects completed and underway.

Completed Projects:

VTE Prophylaxis:

Venous thromboembolism comprises deep vein thrombosis (DVT)and pulmonary embolism (PE) and strikes more than 1 in 1,000adults per year, causing discomfort, suffering, and occasionallydeath. DVT is defined as blood clots in the pelvic, leg, ormajor upper-extremity veins. These clots can break off fromthe veins, travel through the heart, and lodge in the lung arteries,causing potentially deadly PE. According to the National Quality Forum more than 90,0000 people in the United States suffer from a DVT annually of which 500,000 are PE. This number may be significantly higher because many cases occur without obvious symptoms and are never detected.This illness is often "silent" and can mimic other common conditionssuch as heart attack, pneumonia, and anxiety. The DVT spectrum can range from an inconsequential clot to a fatal pulmonary embolism.Awareness of DVT and PE is the best way to prevent this condition.Medical professionals have recognized DVT for almost two centuries,but until recently, only about half of patients in the United States were informedabout the disease. Without knowledge of DVT as a medical problem,the public could not engage healthcare providers to discusslifestyle changes and more intensive measures that usually succeedin preventing this illness. Multiple national campaigns and the Society of Hospital Medicine’s task force initiative has resulted in hospitalists becoming pivotal in institution-wide prevention strategies.Our institution decided to tackle this problem with the creation of a system-wide VTE Prevention Task Force with full institutional support . The task force was created in late 2007 with Dr. Surrendra Khera, chief of the Section of Hospital Medicine and Dr. Bimalin Lahiri, chief, Section of Pulmonary and Critical Care as co-chairs. A multi-specialty and multi-disciplinary group was assembled and key goals, objectives and evidence-based best practices were identified to protect patients from DVT. Guidelines we created and became operational on May 13th 2008. The results of this intervention were truly phenomenal. The hospital-wide VTE prophylaxis compliance rate soared from under 40 percent to the current compliance rate of over 95%. "It truly is a success story. How did we achieve this," Dr. Khera said. "Team work, collaboration and raising grassroots awareness, while diligently plodding away at the non-compliant elements within the institution.” The challenge, he said, is to keep the momentum. "We just have to keep going until every single patient, every single admission order and every single SFH caregiver is recruited into battle against the “killer legs,” Dr. Khera said.

Implementation of Problem List in Hospital Electronic Health Record:

This project was undertaken to comply with federal “Meaningful Use” guidelines. Under these guidelines, all patients admitted to the hospital should have at least one current problem entered in their problem list in the electronic health record (EHR). Dr. Sudeep Bansal (AIMS hospitalist) and Dr. Jeffrey S. Menkes (ED Physician) played a major role in the project to help guide the IT department in the design, implementation and development of policies. Currently, Saint Francis Hospital’s compliance is greater than 90%, well above the required 80% per federal guidelines.

Ongoing Projects

Quality and Safety of Discharge Process at Saint Francis

IntroductionWhile there have been differing opinions on the urgency for 11 a.m. discharges, it is clear from our experience at Saint Francis Hospital and Medical Center that delayed discharges create major patient flow bottlenecks, especially at peak demand times. These crunch times include late afternoons and post-weekends. There is also ample data to suggest that discharges later in the day are potentially unsafe especially for the “complex” discharges (patients with multiple co-morbidities and multiple needs, including visiting nurse and skilled nursing facility discharges). Apart from patient flow, there are multiple other advantages to early discharges including patient satisfaction and surprisingly even a LOS reduction as the entire system goes into an efficiency mode.Preliminary Process The AIMS group undertook an 11 a.m. “Discharge Order Insertion” pilot starting on March 14, 2012. We have already seen an almost six-fold increase in the number of discharge orders inserted prior to 11 a.m. More details of this project will follow.

Implementation of Computer-based Processes to Improve Patient Quality

Under the direction of Dr. Sudeep Bansal, the AIMS hospitalist group is collaborating with the Saint Francis Health Information Systems (HIS) Department to help implement and/or improve a number of physician-oriented projects including:

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